No Amount of Alcohol Safe in Pregnancy

Alcohol in reproductive age group of women should be discouraged since it leads to dysmormphic feature in those indulging in it as per a study.

Team@CMHF

Prenatal exposure to alcohol is associated with a variety of dysmorphic features in the offspring of exposed mothers, as well as low birth weight and length and small head circumference, but the exact timing and dose of exposure associated with these findings are uncertain.

This analysis by Feldman and colleagues of a prospective cohort of pregnant women with alcohol exposure during pregnancy examines the association between dose and timing of alcohol exposure during pregnancy and the risk for dysmorphic features and growth deficiencies.

Study Synopsis and Perspective

With respect to alcohol-related birth defects and growth deficiencies, there is no safe amount of alcohol use during pregnancy, confirms a new study based on prospectively collected data on nearly 1,000 women.

“Women who are of childbearing age and who are contemplating or at risk for becoming pregnant should be encouraged to avoid drinking, and women who are pregnant should abstain from alcohol throughout pregnancy,” advised Haruna Sawada Feldman of Pediatrics dept.

Research Challenge

Classic physical features of fetal alcohol syndrome (FAS) include smooth philtrum, thin vermillion border, short palpebral fissures, microcephaly, and weight and height growth deficiencies. Yet, there is a lack of clear-cut information on the risk of each of these specific features in relation to the amount and timing of alcohol consumption in pregnancy.

Dr. Feldman and colleagues quantified risks for these specific alcohol-related features on the basis of specific patterns and timing of exposure during pregnancy. The analysis focused on 992 women and their infants. The mean age of the women was 31 years.

The study was designed to address two challenges in FAS research, Dr. Feldman explained. The first is obtaining accurate alcohol exposure history from the women, which may involve social stigma and recall bias

“The second challenge is getting quality information on physical features of FAS. “These cardinal alcohol-related features are often subtle, and a non-expert examiner may miss or misclassify features, and/or can be biased by subjectivity, especially if he/she suspects or knows about prenatal alcohol exposure,” Dr. Feldman noted.

Higher Exposure, Increased Risk

In each pattern the team investigated, higher prenatal alcohol exposure was significantly associated with an increased risk of having an infant born with reduced birth length or weight or having a smooth philtrum or thin vermillion border or microcephaly.

In the 2nd trimester these associations were linear, and there was no evidence of a threshold, the authors say.

Dr. Feldman and colleagues emphasize in their report that the apparent lack of strong associations for drinking during the first half of the first trimester should not be interpreted to mean that alcohol consumption during this period is somehow safe.

“Due to the study design, we were only able to include women who gave birth to live infants,” she explained in a statement. “Therefore, we did not include women who may have had miscarriages or stillbirths. It is important to know that alcohol-exposed infants who would have exhibited alcohol-related minor malformations might also be more likely to be lost to miscarriage following exposure during the first six-week window,” Dr. Feldman said.

“Important” Study

Lynn Gretkowski, MD, of Stanford University in California, , noted that “the period of embryotoxicity based on timing and amounts (of alcohol) doesn’t come as a surprise, even for prescribed medicines in the first trimester. Insults certainly can be lethal at this gestational age,” she said.

Research on the effect of prenatal alcohol exposure has been mixed. One of the more recent studies published in 2010 in Pediatrics and reported by Medscape Medical News at that time found no link between low and moderate alcohol consumption during pregnancy and alcohol-related birth defects. There was, however, a significantly increased risk for birth defects with heavy prenatal alcohol exposure, as expected.

Dr. Feldman’s team says it should be noted that their study focused only on alcohol-related physical features. Far more children with prenatal exposure to alcohol may be affected neurobehaviorally, the authors note.

“Future studies should address these same questions regarding gestational timing and dose relative to neurobehavioral outcomes,” they advise.